Specialists are special physicians, not just doctors but lords of medical dominions. A Specialist must do several things to the patient—Specialists do things TO people, not for them—because we are special. We spent many years after medical school bringing out the Specialists in ourselves. To that end, the following represent the essential techniques of the Specialist.
1. Make the patients wait longer in the waiting room than they do at the primary doctor’s office. Patients must not think that Specialists are waiting around hungry for consultations. Check with the primary docs about their wait times to determine how long to make the patients wait.
2. Make the patient disrobe. A certain amount of dehumanization is required to sustain the Specialist’s aura.
3. Use highfalutin vocabulary, with an emphasis on Greek roots, in conversation with the patient and office staff. Dr. Sal Monella tries to drop in “prosopagnosia,” “sphenopalatine ganglioneuralgia,” or “auscultation of borborygmi” into consultations and office jargon whenever possible (he also refers to himself in the third person).
4. Order obscure laboratory tests that cannot be translated sensibly into lay terms. You want patients to say things like, “he ran a test to see if I’m related to a Sasquatch.” See to it that the referring physician cannot interpret the results, either. Ordering obscure tests is perhaps the most important job of the Specialist.
5. Use the phrase, “it’s actually quite simple” before or after describing a complicated procedure with multiple risks, such as hematopoietic stem cell transplantation.
6. Hand out a busy business card with several titles and a 6-line (minimum) address but no real way to contact the physician with questions or problems.
7. Be observed mumbling incomprehensibly into a Dictaphone, pimping a medical student, or berating a resident at various times during your clinic. Refer to item 3, above.
8. Answer questions in the most circular manner possible, so that patients or colleagues have more questions after the response. Nevertheless, since your answer was circular and overwhelming, your questioners are intimidated and reluctant to ask anything else. Refer to item 5, above.
9. Send a consultation note in which the Impression/Recommendations section has lots of ICD-10 billing codes, but only two lines (at most) of medically relevant material, so that the referring doctor does not learn how to manage problems in your specialty, or even worse, explain things better than a Specialist.
10. Perform an invasive procedure if possible so that the patient has a memento (a scar, physical and emotional) of the visit. This also contributes to dehumanization. Procedures are key to establishing Specialist status.
11. Work with the hospital or clinic to send the patients astronomical bills—it is OK if they are largely written off or paid by insurance—so they appreciate just how valuable you truly are.